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Home My Public Portal About5147 GOLDEN WEST AVE_Building__ � LI, _ APPLICATION FOR BUIL NG PER •76AG ACE#80 8-84 00UNTY OF LOS ANGELES ABUILDING DDRESS DEPARTMENT OF COUNTY ENGINEER77(7 BUILDING AND SAFETY DMSION LOCALITY P. JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W JENKINS¢UP T OF BUILDING CROSS ST DISTRICT NO ,G TYPE P SMB Y FOR APPLICANT TO FILL IN CONST ' BUILDING 1 STATISTICAL+C _!r7 FICATION' SEWE AP ADORE SS CLASS NO OWELL UNITS.57 42 BK -G�I LOT NO BLOCK �� USE O E MAP _ NO. TRACT 3 SPECIAL - NO OF BLDGS = CONDITIONS SIZE OF LOT I,`I' NOW ON LOT ~ USE OF NG ✓w��'L/A A r " � f' �� BLDG SETBACK FROM - I OWNER �f D /V TEL21F -,fq FRONT PROP. LINE OF, - (STREET) 1, TYP E,OF EXISTING SETBACK HIGHWAY-,+ YARD - TOTAL ADDRESSA,� HI 'W Y I �F M E L ` BLDG SETBACK FROM. ARCHITECT OR TEL SIDE PROP. LINE OF (STREET) ENGINEER NO "'�� TYPE OF- EXISTING SETBACK HIGHWAY' + YARD- '= TOTAL ADDRESS HIGHWAY WIDTH FROM C L d TEL [,f., 1 + = O CONTRACTOR NO- ,,5--66 Z LO, CORNER CUTOFF YES NO O S6 'ADDRESiAt f NO CITY r �= cls SEE•REVERSE SIDE FOR SPECIAL APPROVALS u DES RIPTION OF WORKlul ` /, a NEW ADD/. ALTER REPAIR DEMOLISH SQ.FT `NO OF NO 'OF p 4./�X`�q T O'- �,,ap ✓P'�J�// p. SIZE S STORIES FAMILIES -'e � m^l , \v` �Lf6 lO)nt-f .d✓3�1 _ v vf'�Nti'i STRUUSEO TURE FA04li- Old + SIGNATURE OF APPLICANT VALUATION$ o " APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT FOUNDATION, LOCATION n/ / FEE$ FEE$ FORMS•,'MATERIALS __- Y►` FRAME, FIRE STOPS, IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION Z 0 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS SUILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK r AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH INT `�\J TION OF THE LABOR ODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN S O PEN TION INSURANCE LATH EXT SIGNATURE OF HOUSE NUMBER COR- SIGNATURE - -RECT AND POSTED 7--1 -,//DDRESS F I N A L S (t =PLAN CHECK VALIDATION CK Mo cnsH — JOHN F LEWIS PRI CIPAL ST OCTAL ENGINEER PERMIT VALIDATION, CK M D CASH LA] 12691.0 5 1 D 22.0 v WORKERS',COMPENSATION DECLARATION .� ti �,� .✓ ^_, _� �, y, �M., _, _ f,� e, or o FOR -. PERMIT . - 11 Gafirm reeinsurfWa certificate n , U or a certified Opy thefeof (Se3800b COUNTY OF LOS ANGELES 1 BUILDING,.AND SAFETY ,;r :y' Policy No f f jn'1� ,Compan BUILDING ❑ tCertrfied copy.'is hereby furnished FOR APPLICANT TO FILL IN _ ADDRESS _ Ceritf d copy is`filed with"the county buildmg•mspec- BUILDING1 I homdepbrtment "' ADDRESS 51'4 Date L-L .C •Applicant CITY 1� ZIPy LOCALITY t CERTIFICATE OF EXEMPTION FROM VV RKERS' ` -'-" - _ -NO-,OF BLDGS- - NEAREST_ ""COMPENSATION INSURANC ';� SIZE OF LOT NOW ON LOT. CROSS (T•his''sectionlneed not be�completed if-the permit is-forrone - -- -^ -r' - - ASSESSOR - ! r -`•"+'�:• hundred_ dollars($100)or,less ) TRACT BLOCK LOT NO MAP'BOOK } 1 PAGE! PARCEL t• S` rs'• 1, ,.. r - TEL _ USE Z NE MAP OWNER': n' -NO` e Ih,cerhfy that m the performance of the•work for whch this NO pe`rmd is issued, I shrill not empl'o'y any person in any manner ` ` �', SPECIAL i s ` - - - :O 'ADDRESS,51 C�1(Ae� CONDITIONS so'as to'became subject'to'the Workers'Compensahori Laws A nr• Date 1. Applicant, l, 6 CITY. NOTICE TO APPLICANT' if,•'6_fter'm6king this Certificate of ARCHITECT OR TEL DISTRICT- GROUP, TYPE r; FIRE.-_ . ESSED BY. _ E' _�_. ENGINEER_ __ _ __ NO_- - _ r CONST, ZONE Exemption;:you= should �1i4 ome subject' to 'the':Workers' p l-^ Compensation provisions of the-Labor Code;tyou must forth~ ADDRESS ��0 -�: - + -• with comply with.such provisions or.this permit shall be TEL _ S { deemedr evoked ;, }; •w CONTRACTOt� .l ANO(�)J STATISTICAL CLASSIFICATION APT CONDO t LICENSED CONTRACTORS DECLARATION-0-,, .. - S�Q LIC CLASS NO 2� L r—DWELL UNITS ;• I hereby affirm that I am licensed under provisions of Chapter 9, ADDRESS $(y�� SEWER MAP I y� (commenting with'"Section;7,000)of'Divlsion 3 of the•Business and, . . _ _ .. G _. _ -�_- U6 = Professions Code, and my Icense is in full force and 'effect CITY�tN CLA55 C r3 - '" 'VALIDATION �•.. a S= BK PG t t Q�R tn; _- SQ•FT _- NO OF NO OF,' License Numbe38 w"�` ' Lc Class `';w SIZE STORIES FAMILIES ONE 1;• .r�• { r,• �} stru- t . ; _ y_.� _ ❑ VALUATION I _ 1 Conir6cto�''w' (] Q DESCRIPTION OF WORK"�" '" ' ' " NEW.- - �f/ �' Y �o � Date -1 � -v ❑ $ "/LG:,00 ❑ y -C�:7 B I am exempt under Sec ADD .' _ � •i _ - ALTER D - - ..,t"'xns B-8P C for this reasonREPAIR ❑ $ "-"` �• _ D6Te - USE OF s , EXISTING BLDG' DEMOL ❑ _ _ Signature+ "` " APPLICANT TEL FINAL OWNER-BUILDER DECLARATION PRINT NO .—DA TE• r•r1•'hereby affirm•ihat•I am-exempt from the Contractor's License _ -, r �' v 3 �� Law for the followin63re6sone(Section 7031 5, Business and ADDRESS FIN ( '. ��`t' Pr`ofessioris Code)" '- PRESENT B Y BUILDING ❑- 1, as owner of the_prope�ty, or_my employees with ADD_R_ES_S _ _ _ y Y r t wages as their sole compensation,will do the work and LOCALITY ' the structure isnot intended or offered for"sale(Section � - '• ` ''7044,'Business and Professions Code) MOVING- I, as owner of the property, am exclusively contracting CONTRACTOR NO f a ''with licensed-contractofs to*construcf'tFfe project'(Sec- tion 7044, Business and Professions Code) ADDRESS , t i " CONSTRUGTION,LENDING AGENCY '•6• REQUIRED 'YARD` :HWY'- TOTAL SETBACK ( _.. . _ _ _ _. 1, SET BACK PROP LINE +'WIDTH I he'r`eby affirm that there is o constructtori lending agency for FRONT t t #'o_e.o • o '? -the performance of-the work for-which this permit-Is,issued - P L k - - - - --- - - - -- = - (sec 3097, Civ•C ) SIDE I • 5;9 2 5:' ` Lender's Name .. _ _. P L - - - - • v o 5,9.1'2' 5=t * __ LD Ref N _ ^ U P C'Fee$ "' - Permrt'Fee" "' '-` s - Lender's Address •-+ � �. ,� O �,�,��, .•,8 6,,�, ; I-certify that-I have-read this opplcahon-and-state that the _ - - ,_ Issuance-Fee — �7 " a above information is correct I agree to comply with all County Investigation Fee ,,.ordinances and State_laws relatin to building construction, _ •� + and,hereby authorize representatives of this County to enter - -"` = " Total Fee -i 2- • LDMA Perm #f` - -- ' ' • k Y . upon.th obo a-menti necl rpperty for inspection:a purposes a SEE REVERSE FOR EXPLANATORY LANGUAGE"'' r ` '• _.-. Signature f Applicant or Agent-- - -._ Date' a ..•--t�....... - -__._ _�...,.. _ .. ._. --..---- •T- ---'.- •_..i.^a,_«,....... _ ..._`_ � - -. n w_. _ .._ _. ...'Ov i' WORKERS'COMPENSATION DECLARATION •,.1' _eTe Syi affirm that I+have a certrficat",a consent to self �� ®� '.F®�, BU •I L D I N G PERMIT insure; or•a �ertificate'of Workers: Com nsotion Insurance, or a'certified copy thereo# (Sec"38b0, Lab' C ) COUNTY OF LOS ANGELES' BUILDING AND SAFETY, 4l. Policy, Company . Certified copy is hereby•furntshed FOR APPLICANT,TO FILL IN BUILDING ❑ ADDRESS f 7 Gomer uAtil Certified copy is filed with the county building'inspec-,,• - BUILDING f n ��.1 d ` tion department ADDRESS 7 / �� 'wv'. Y �( CA . ' '• }y- Date• Applicant w CITY % G ZIP'', . LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' ,1 7- I y NO,OF_BLDGSNEAREST, COMPENSOLS ATION INSURANCE SIZE OF LOT J4 L - NOW ON LOT - / CROSS ST ..� , This`section need not be coin leted if the permit is fortune =' ' Ste' ASSESSOR ; (. ,` p p ,. TRACT BLOCK '1 LOT NO MAP BOOK PAGE PARCEL hundred'dollars ($100)or,less ) , USE NE MAP � _, •. � -;. TEL �Q , ]-certify that in the performance'of the'work for which'this OWNER • �� /6' NO •�C/� NO ' ' permit is issued„I shall not employ any person in any manner' SPECIAL M i so'as to become subject to the Workers'Compensation,Laws ADDRESS CONDITIONS 0' CITY C/S Date” Applicant D el -NOTICE'TO APPLICANT':If, `after'•making this Certificate'of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY• O Exemption;-you should 'become subject to, the Workers' ENGINEER 'NO CONST / ZONE s• Uta Compensation provisions,of the.Labor,Code, you must-forth- ADDRESS �'1 �\// I- Lel,= with comply with such provisions;or this permit shall, be TEL STATISTICAL C1A551F CATION APT CONDO, [q deemed revoked- CONTRACTOR ' +NO ��;� T"/. Z n LICENSED CONTRACTORS DECLARATION • ' CLASS NO DWELL UNITS - I hereby,offirm that I am licensed-under'provisions of Chapter 9• ADDRESS (Zml NO' (commencing with Section 7000)of'Division 3 of the Business and LIC 'SEWER MAP Professions Code,'and my license is !in full'force and effect CITY C&bT C12W CLASS 6� - VALIDATION Y'M SQ FT NO OF NO OF CHECK BK PG License Number' ` Lic Class SIZE, STORIES FAMILIES C. 'ONE % 't _- - VAL TIO/� DESCRIPTION WORK Sjuh/ NEW ❑ //a Contractor DA7ate' ' $ Y/ ADD `El I am exempt der'Sec `- D - ❑ ." o ALTER B&P C for this reason REPAIR ❑ S ` Dote USE OF EXISTING BLDG DEMOL '❑ J p " t APPLICANT TEL D ' O 2 �'S A Signature PRINT O * _ NO FINAL OWNER-BUILDER DECLARATION -DATE 4J # I,hereby affirm that,l,am exempt from the Contractor's Lice°n"se LtW�T Law for the following'-reason'(Sectfon.7031 5, Business and ADDRESS' - �� G fes+ t� / FIN I;+•f1 2�I 8 8 Professions'Code) PRESENTsY 2 BUILDING ,* iF ,,� .2.4 8 8 r. ''I, as owner ofi'the property, or my''employees with - ADDRESS , o 0 wages as their sole compensation�'will do the work and = "'r' t , t a' .> the'-structure is not intended or offered for sole.(Section r - LOCALITY- fit` 7044, Businesi,ond Professions Code) "',-, MOVING TEL F ',' I', as,owner of the property,pin exclusively contracimg.'r CONTRACTOR NO r o�'1 588, . • • • with licensed continctors to construct the protect (Sec--' ADDRESS '� b-, - � �• � - `° •z � c't' • tion 7044, Business and Profession's Code) t ,'� 'i• r, 6w `_ a CONSTRUCTION LENDING AGENCY ` REQUIRED YARD -HW TOTAL SETBACK SET BACK PROP LINE WIDTH. hereby affirm that there construction.lendirig agency for FRONT - 1 .a �' "tier-' the e'rformance.of the t' - .t nti p e.work for which this permit is issued P L ;' !' (Sec 3097, Civ C ) SIDE e Lender's Name �' LDMA Ref #° u ti i ♦ i •.l Lender's Address - P C'Fee$ Permit Fee - L d to ^rPol '�. 1'* 000, - ,, , ." ,:'�• I•certify that I have,read this application,and state that the `�" Issuance Fee" CDMA P/.C'# 4 above information is correct I agree to comply'with all County "• Invests anon Fee o' - ordiria_hces and-State laws-relating to building construction, g , "Total Fee CDMA Perm # i '•" ' and,hereby authorize representatives oHhis County to enter upon the-a - enti ed property for inspection purposes +;• SEE REVERSE FOR EXPLANATORYLANGUAGE ignoture of A ant or Agent Date